Nelda Mier

The science of sustaining health behavior change: the health maintenance consortium.

OBJECTIVE To enhance understanding of the long-term maintenance of behavior change, as well as effective strategies for achieving sustainable health promotion and disease prevention through the Health Maintenance Consortium (HMC). METHODS This introductory research synthesis prepared by the resource center gives context to this theme issue by providing an overview of the HMC and the articles in this journal. RESULTS It explores the contributions to our conceptualization of behavior change processes and intervention strategies, the trajectory of effectiveness of behavioral and social interventions, and factors influencing the long-term maintenance of behavioral and social interventions. CONCLUSIONS Future directions for furthering the science of maintaining behavior change and reducing the gaps between research and practice are recommended.

Anatomy of culturally sensitive interventions promoting nutrition and exercise in hispanics: a critical examination of existing literature.

Compared with non-Hispanic Whites, Hispanics experience a disproportionate burden of chronic diseases. Understanding the factors influencing the success of health programs in Hispanics requires a clearer examination of the principles and components of tailored interventions. This research comprises a comprehensive literature review of randomized controlled trials testing nutrition and exercise interventions tailored for Hispanics and an examination of how these interventions were constructed. The review of 18 interventions meeting study criteria suggests that most tailored programs promoting nutrition and exercise in Hispanics are theory driven and are informed by formative research. Also, the findings indicate that salient culturally sensitive intervention components are (a) bilingual and bicultural facilitators and materials, (b) family-based activities, (c) literacy-appropriate materials, and (d) social support. A clear understanding of Hispanic cultural values is also required. Further empirical examination is warranted to determine the factors mediating or predicting the efficacy of culturally sensitive health programs for Hispanics.

Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border

Understanding influences on health-related quality of life (HRQL) is critical in order to track and improve the health of poor, vulnerable populations and reduce health disparities. However, studies assessing HRQL of minorities are relatively scarce. The purpose of this study was to document personal and socioenvironmental correlates to HRQL. The study population is Mexican Americans in the Texas-Mexico border region living in colonias - unincorporated, impoverished settlements with substandard living conditions along the U.S.-Mexico border. Mexican Americans living in colonias are one of the most disadvantaged, hard-to-reach minority groups in the United States. We used data from the Integrated Health Outreach System Project collected in 2002 and 2003. Our sample included 386 participants randomly selected and interviewed face-to-face with a structured survey. We measured HRQL and examined personal and socioenvironmental correlates. Unadjusted and adjusted (multivariate) logistic regression models were used for data analyses. We found that border Mexican Americans living in colonias were of similar mental health status compared to the general population of the United States, but worse off in terms of physical health. Poor education and long-term residency in colonias were predictors of lower physical health. Women reported worse mental health than men. Length of time living in a colonia, co-morbidity status, and perceived problems with access to healthcare was associated with poorer mental health status. This study provides information for health professionals and policymakers and underscores the need to provide better preventive and medical services for underserved populations. Major findings indicate the need for additional research centered on further exploration of the impact of economic, cultural, and social influences on HRQL among severely disadvantaged populations.

Clinical Depressive Symptoms and Diabetes in a Binational Border Population

Background: Depression affects more Hispanics with type 2 diabetes than other ethnic groups. This exploratory, binational study examined the prevalence and correlates of clinical depressive symptoms in Hispanics of Mexican origin with type 2 diabetes living on both sides of the Texas Mexico border. Methods: Two binational samples, consisting of 172 adult patients of Mexican origin with type 2 diabetes in South Texas and 200 from the Northeastern region of Mexico, were compared. Logistic regression analyses were used to test personal and social correlates to clinical depressive symptoms. Results: The rate of clinical depressive symptoms was similar in both South Texas and Northeastern Mexico patients (39% and 40.5%, respectively). Gender, education, emergency department visits, and burden of diabetes symptoms were predictors of clinical depressive symptoms in the South Texas sample. Among respondents in the Northeastern Mexico sample, the only statistically significant correlate to clinical depressive symptoms was the burden of diabetes symptoms. Conclusions: Diabetes and depression must be addressed as priorities in diabetes initiatives at the US Mexico border region. Further research is warranted to examine the extent and impact of involving family practice physicians from both sides of the border in depression screenings among patients with type 2 diabetes.

Successful Falls Prevention Programming for Older Adults in Texas Rural–Urban Variations

This study assessed health-related changes of participants attending A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model falls-prevention program for older adults based on their residential location. Data were examined from 1,482 older Texans enrolled in AMOB/VLL over a 2-year period and assessed at baseline and postintervention. Results indicate participants significantly increased falls efficacy by an average of 14.4% (p < .01), reduced activity interference due to their health by an average of 6.5% (p < .01), and decreased the number of days limited from usual activity by an average of 28.2% (p < .05). Regression models show that rural participants, despite entering and exiting the program with lower health status, report greater rates of positive change for falls efficacy and health interference compared with their urban counterparts. Findings contribute to the understanding of geographic variation with falls-prevention program outcomes.

Pilot of a Diabetes Primary Prevention Program in a Hard-to-Reach, Low-Income, Immigrant Hispanic Population

An immigrant Hispanic population in the Texas-Mexico border region urgently requested assistance with diabetes. The project team implemented an exploratory pilot intervention to prevent type 2 diabetes in the general population through enhanced nutrition and physical activity. Social networks in low-income rural areas (colonias) participated in an adaptation of the Diabetes Empowerment Education Program. The program had a pre-post-test design with a comparison group. The intervention had a small but significant effect in lowering body mass index, the biological outcome variable. The process evaluation shows that the participants valued the pilot project and found it culturally and economically appropriate. This program was the first primary prevention program in diabetes to address a general population successfully. The study shows that low-income, rural Mexican American families will take ownership of a program that is participatory and tailored to their culture and economic situation.

Bridging Research and Policy to Address Childhood Obesity Among Border Hispanics A Pilot Study

BACKGROUND Mexican-American children are disproportionately affected by obesity compared to other population groups. Although national guidelines recommend using environmental and policy approaches to address this public health issue, the majority of Mexican-American children do not meet physical activity recommendations. PURPOSE To describe a knowledge transfer process involving local decision makers to address childhood obesity and physical activity needs among low-income, Mexican-American children and to examine environmental policy recommendations generated in this process. METHODS This pilot study employed a qualitative research design that included the dissemination of primary research data to local decision makers in the Texas-Mexico border region. Stakeholders attending public meetings were briefed about a research project reporting on the physical activity needs of Mexican-American children from impoverished neighborhoods known as colonias. Seventy-four stakeholders responded to an unstructured questionnaire and proposed policy recommendations. Data were collected January-April 2011 and analyzed July-September 2011. Data were analyzed using a content analysis technique. RESULTS Four policy themes emerged from the data: (1) establishing sustainable community-based health programs; (2) improving neighborhood infrastructure and safety; (3) increasing access to parks; and (4) supporting community organizations to disseminate health education to parents and children. CONCLUSIONS Knowledge transfer processes planned and facilitated by researchers at public meetings with local decision makers are effective methods to influence policy development related to childhood obesity.

Factors influencing health care utilization in older Hispanics with diabetes along the Texas-Mexico border.

Little is known about predictors of health care utilization for older Hispanics with chronic conditions. This study aimed to determine: (1) the level of health care access for older Hispanics with type 2 diabetes living in a US-Mexico border area; and (2) personal and health correlates to health care utilization (ie, physician visits, eye care, emergency room [ER] use). This was a cross-sectional study based on a community assessment conducted at a clinic, senior centers, and colonias. Colonias are impoverished neighborhoods with substandard living conditions along the US-Mexico border. Hispanics living in colonias are one of the most disadvantaged minority groups in the United States. The study sample consisted of 249 Hispanics age 60 years and older who have type 2 diabetes. Descriptive analyses, multiple linear regression, and generalized linear models were conducted. Older age (P = 0.02) and affordability of physician fees (P = 0.02) were significant correlates to more frequent physician visits. Factors significantly associated with eye care were being insured (P = 0.001) and reporting high cholesterol (P = 0.005). ER use was significantly associated with younger age (60-64 years old; P = 0.03) and suffering from hypertension (P = 0.02). Those who received diabetes education (P = 0.04) were less likely to use the ER. Identifying patterns of health care utilization services in aging underserved minorities who are disproportionately affected by diabetes may lead to culturally appropriate preventive practices and timely access to health care. Adequate health care access can decrease or delay the onset of diabetes complications in older Hispanics with type 2 diabetes who live along the US-Mexico border.

Translating science into public health practice: Lessons from physical activity interventions

It has been 10 years since the Surgeon General’s office ssued its landmark report on physical activity (PA), spellng out the scientific evidence for the health benefits of hysical fitness and urging Americans to exercise more. oday, despite an ever-growing evidence base and conerted efforts to get out the “get fit” message, Americans’ xercise patterns have changed little [1]. Why is this, and hat can be done? In light of the rapidly growing populaion of older adults, who stand to gain the most benefit from ncreasing PA, finding answers to these central questions as never been more urgent. There is clear consensus that PA is one of the best things eople can do for their bodies and minds, in terms of both imiting disease and improving quality of life [2]. Numerous ational and regional health surveys and prospective interentional studies variously conclude that regular PA inreases physical functioning and the ability to engage in ctivities of daily living [3]; reduces the risk and burden of oronary heart disease, hypertension, type 2 diabetes, colon ancer, and osteoporosis [4]; and extends years of life [1,5]. eviews in this supplement detail the growing evidence that A protects against cognitive decline, on the basis of epiemiologic studies, animal research, and prospective human rials [6–8]. Strong evidence also supports the relationship etween PA and emotional well-being. Moreover, by reducng cardiovascular risk, PA also lowers risk for cognitive ecline and dementia [9–11]. Thus, increasing one’s level of PA is not only directly ssociated with maintenance of cognitive health but might lso prevent cognitive decline indirectly by reducing cariovascular risk factors, although further research is war-

A pilot walking program for Mexican-American women living in colonias at the border.

Purpose. To test the effectiveness of ¡Vamos a Caminar! (Lets Walk!), an intervention for Mexican-American women living in economically disadvantaged, poorly urbanized areas in the South Texas border region. Design. This was a nonexperimental, one-group, pretest and posttest intervention with a duration of 12 weeks. Setting. The intervention was conducted in Hidalgo County, Texas, 1 of the 10 poorest counties in the United States, located at the border with Mexico. Participants resided in areas known as colonias, which are unincorporated and impoverished settlements along the border where many people live in trailers or self-built houses and lack basic services. Subjects. Spanish-speaking Mexican-American women (n = 16) 18 years of age and older. Intervention. The program was home-based, culturally sensitive, theoretically driven, and facilitated by community health workers. Measures. Changes in walking levels, depressive symptoms, and stress levels were assessed. Analysis. Descriptive statistics and the Wilcoxon matched-pairs signed-ranks test were used. Results. A majority of participants were unemployed, had low levels of education, were born in Mexico, and were obese. After exposure to the program, the participants reported a significant increase in walking (915.8 metabolic equivalent min/wk; p = .002) and lower depressive symptoms (p = .055) and stress level scores (p = .017). Conclusions. Culturally sensitive programs promoting walking in underserved, minority populations are promising in reducing physical activity disparities. (Am J Health Promot 2011;25[3]:172–175.)